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Venous Thromboembolism and Mild Thrombocytopenia after ChAdOx1 nCoV-19 VaccinationFunding Funding support for this work was provided by a grant from the Canadian Institutes of Health Research (CIHR #452655) awarded to Dr. Ishac Nazy.
Thrombocytopenia and thrombosis have been reported following vaccination with the ChAdOx1 nCoV-19 (AstraZeneca) vaccine, an adenoviral vector COVID-19 (coronavirus disease 2019) vaccine.     Previous cases of vaccine-induced immune thrombotic thrombocytopenia (VITT) have been reported with symptom onset between 5 to 30 days postvaccination, typically with severe thrombocytopenia, unusual thromboses, high mortality, and platelet-activating antibodies against platelet factor 4 (PF4) despite no previous exposure to heparin.   Here we report two patients with VITT presenting as lower limb venous thrombosis (one with concurrent pulmonary embolism) and mild thrombocytopenia. One had a late presentation 31 days postvaccination. Both patients were shown to have platelet-activating antibodies in a PF4-dependent serotonin-release assay (SRA).
N.G., T.A., and S.P. delivered patient care and provided clinical data; N.G. and T.A. prepared the initial manuscript draft. I.N. and D.M.A. provided laboratory supervision. M.P. supervised the clinical data collection. J.I.S. reviewed laboratory data and devised an explicatory figure. T.E.W. interpreted the data and provided critical revisions to the manuscript. All authors reviewed drafts of the paper and approved the final version of this communication.
* These authors contributed equally to this work.
Received: 10 June 2021
Accepted: 06 August 2021
Accepted Manuscript online:
12 August 2021
Article published online:
23 September 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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